Safety and efficacy of carbon fiber-reinforced polyetheretherketone implants in primary and metastatic spinal tumors: a systematic review and meta-analysis
In brief
Carbon fiber spinal implants have a 3.5% hardware failure rate, matching titanium outcomes
In a pooled analysis of 1,609 patients, carbon fiber-reinforced polyetheretherketone instrumentation showed a 3.5% hardware failure rate, 3.9% infection rate and 6.2% reoperation rate, with no statistically significant differences compared with titanium implants. While safety appears comparable, limited follow-up and heterogeneous study designs leave the impact on long-term survival uncertain.
- Journal
- European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society (Q1)
- Published
- 30 July 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Leonardo Di Cosmo, Ely Feffer Barak, Jad El Choueiri, Christopher Peter Imbrogno, Lucca Tamara Alves Carretta, Lorenzo De Rossi, et al.
- PMID
- 42530597
- DOI
- 10.1007/s00586-026-10223-9
Why clinicians should know about it
- Picked for Epidemiology (top studies of the week, 2 August 2026).
- Picked for Orthopedics and Sports Medicine (top studies of the week, 2 August 2026).
Abstract
BACKGROUND: Carbon fiber-reinforced polyetheretherketone (CFRP) instrumentation is increasingly used to manage primary and metastatic spinal tumors due to its radiolucency and similar biomechanical properties to titanium implants, which facilitate radiotherapeutic planning and postoperative surveillance. However, whether these advantages translate into comparable or improved clinical outcomes relative to conventional instrumentation is unclear. METHODS: Following PRISMA guidelines, databases were searched through November 2025 for studies evaluating CFRP instrumentation in adults undergoing surgery for primary or metastatic spinal tumors. Randomized controlled trials, prospective, and retrospective studies reporting at least one clinical outcome were included. Random-effects models were applied, with relative risks (RR) used for dichotomous outcomes and mean differences (MD) for continuous outcomes. RESULTS: A total of 1,609 patients were included, comprising 1,421 treated with CFRP and 188 with titanium instrumentation. Single-arm pooled prevalence analyses included all eligible studies, whereas comparative analyses were restricted to the four studies directly comparing CFRP and titanium instrumentation. The pooled hardware failure rate for CFRP was 3.5% (95% CI 2.3-5.2%), infection rate 3.9% (95% CI 2.1-7.3%), reoperation rate 6.2% (95% CI 3.8-9.8%), and recurrence rate 10.0% (95% CI 6.3-15.6%). Comparative analyses demonstrated no significant differences between CFRP and titanium instrumentation for hardware failure (RR 1.17, 95% CI 0.35-3.97; p=0.796), infection (RR 0.70, 95% CI 0.17-2.97; p=0.632), reoperation (RR 2.88, 95% CI 0.68-12.21; p=0.150), or tumor recurrence (RR 0.50, 95% CI 0.21-1.18; p=0.113). Operative time, length of stay, and survival analyses varied significantly across studies and were inconsistently reported, precluding pooled analyses. CONCLUSION: In patients undergoing surgery for primary and metastatic spinal tumors, CFRP instrumentation shows complication, reoperation, and recurrence rates comparable to titanium implants. However, whether these advantages translate into improved long-term survival outcomes remains unclear. The current literature is largely observational, with limited follow-up and heterogeneity in patient populations and adjuvant treatments. Further prospective, multicenter, and propensity-matched studies are needed to clarify the impact of CFRP instrumentation on long-term outcomes and to define its role in spinal oncologic surgery.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.